Hybrid Provider Enrollment & Credentialing Specialist

cayugahealthsystem; Town of Ithaca (NY); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Centralus Health is seeking a Provider Enrollment Specialist to manage provider enrollment data and ensure compliance across the Cayuga Health Partners Network and Centralus Health. The role involves completing enrollment applications, coordinating with health plans, and maintaining accurate provider rosters.

The position reports to the CHP Director, Provider Enrollment, and requires 2–5 years of related experience with credible credentialing knowledge.

Qualifications

• Education - Associate's degree required.
• Experience - 2–5 years of provider enrollment or credentialing experience with IPA/Medical Group/Hospital or related healthcare operations.
• Licensure - None required
• Notary Public certification preferred.

Responsibilities

• Perform provider enrollment activities as necessary.
• Manage the completion and submission of provider enrollment applications for CHP providers according to plan specifications.
• Review and assess for completeness of enrollment documents (licensure, liability insurance, DEA, etc.).
• Follow-up with physicians and providers on missing information needed to complete enrollment.
• Generate, mail, track, and process provider revalidation applications; liaise with health plans and CHP participants.
• Update Provider Data Management System when new information is received.
• Work with health plans to maintain Provider Rosters.
• Notify health plan and CHP participants of contract termination and membership re-assignment.
• Maintain a current Provider Rosters; communicate changes to CHP staff.
• Maintain extensive knowledge of provider enrollment.
• Be flexible to take on other responsibilities.

Education

Associate's degree

Notary Public certification (preferred)

Job description

Centralus Health is seeking a Provider Enrollment Specialist to manage provider enrollment data and ensure compliance across the Cayuga Health Partners Network and Centralus Health. The role involves completing enrollment applications, coordinating with health plans, and maintaining accurate provider rosters.

The position reports to the CHP Director, Provider Enrollment, and requires 2–5 years of related experience with credible credentialing knowledge.